V.P. candidate Paul Ryan's Medicare plan back in spotlight

Republican Paul Ryan's blueprint for Medicare could prove as polarizing in the campaign as President Barack Obama's health care overhaul has been. Even Mitt Romney may not want to go there.

WASHINGTON — Republican Paul Ryan's blueprint for Medicare could prove as polarizing in the campaign as President Barack Obama's health care overhaul has been. Even Mitt Romney may not want to go there.

Romney's new running mate has built a strong reputation on Capitol Hill for bold ideas to restrain health care costs and federal spending overall. His centerpiece idea is to steer future retirees into private insurance plans, with a fixed payment from the government that may or may not cover as much of a retiree's costs as does the current program.

Ryan, a conservative Wisconsin congressman and chairman of the House Budget Committee, calls his idea "premium support." Democrats call it a voucher plan. In theory, Ryan's plan could work, economists say. But the devil's in the details. Lots of them, and yet to be ironed out.

Ryan would also turn Medicaid over to the states, and sharply limit the growth of future spending on that safety net program. Between them, Medicare and Medicaid cover about 100 million people, touching nearly every American family in some way.

While expressing support broadly, Romney has yet to spell out where he stands on specifics of his running mate's proposals. And that could get tricky.

Mindful of the risks, Romney put gentle but unmistakable distance between his agenda and Ryan's hot-potato budget proposals on Sunday, a day after announcing his running mate's selection. The presidential candidate singled out Ryan's work "to make sure we can save Medicare." But Romney never said whether he embraced that plan himself. During the Republican primary, Romney had called Ryan's budget a "bold and exciting effort" that was "very much needed."

Democrats wouldn't let them off the hook, criticizing the "Ryan-Romney" Medicare plan at every turn.

"From the standpoint of public understanding, the Romney-Ryan ticket has a hill to climb," said health economist Joe Antos of the business-oriented American Enterprise Institute. "I think they can do it, but it's going to require some explaining. I think there are a lot of independents who are going to be nervous."

Seniors vote at higher rates than younger voters, and Medicare matters to them. Concern about Medicare cuts in Obama's health care law helped drive older voters into the Republican camp in the 2010 congressional elections, delivering control of the House to the GOP.

"This puts Medicare in play as a central issue in the campaign," said John Rother, president of the National Coalition on Health Care, a nonpartisan group representing a broad swath of players in the health care system.

The political sensitivities are clear. Polls find that Americans lean heavily on Medicare to help keep them secure after retirement and are suspicious of proposed alternatives, such as Ryan's plan. Surveys also give Democrats an edge over Republicans when people are asked which party people most trust to handle Medicare. Democrats held a 48 percent-39 percent advantage on that issue in a June 2011 AP-GfK poll.

In an interview Sunday on CBS' "60 Minutes," Romney and Ryan both offered words meant to reassure the elderly.

America is about more choices, Romney said, and "that's how we make Medicare work down the road." He said the program won't change for seniors currently counting on the program. Ryan pitched in that his mother is a "Medicare senior in Florida."

For the most part, Ryan's plan would not directly affect people now in Medicare. One exception: In repealing Obama's health care law, Ryan would re-open the Medicare prescription coverage gap called the doughnut hole.

Under his plan, people now 54 and younger would go into a very different sort of Medicare. Upon becoming eligible, they would receive a government payment that they could use to pick a private insurance plan or a government-run program like traditional Medicare. The payment would be indexed to account for inflation, and that could be a problem if health care costs race ahead of the inflation rate.